Using new technology, the health department is expanding its reach in rural areas.Pre-fabricated sub-health centres are coming up in the state.When Pooja Rathore*, 23, was brought to KarmaHealthcare’s clinic in Jaisamand in Rajasthan, she was in a critical condition. The doctors ordered a blood test, found that her haemoglobin level was as low as 2.1 and ordered an immediate transfusion to save her life. All within minutes and from an office more than 45km away in Udaipur.

Telemedicine is not new to India — private hospitals such as Apollo, Narayana Health and Fortis and non-profit healthcare institutions as well as government hospitals have been working on remote healthcare delivery for years — but startups are entering the space to provide the technology know-how and improve delivery of healthcare. And in the process, many have realized that women in rural areas are the ones with least access to healthcare, and have made them the focus of their work.

From advice on understanding sexually transmitted diseases and handling unwanted pregnancies to dealing with breast cancer and depression, startups are using tele medicine to provide rural women a gateway to access professional medical help.

Round-the-clock help

At Rxpress, the youngest caller has been 15 years old. “We get queries from women about menstrual problems, birth control and sex. In traditional households, girls and older women are unable to open up to family members. Being able to talk to a doctor at length, anonymously, is a comfort,” said Madhur Gopal, CEO, Rxpress, which has its own health management app and is also technology partner to Naryanana Health, Bangalore Baptist Hospital and Fortis. The platform, which was launched in April 2015, has about 12,000 registered customers of which 35% are women.Apps have the advantage of providing doctors round the clock, at the other end of one’s smartphone. Rajesh Kumar Singh, CEO of Olito, a Pune-based healthcare startup launched in January 2016, said they get the most calls at night or in the early hours of the morning. “Apps give them anytime access as doctors aren’t easy to contact outside business hours,” Singh said.Startups link specialists in metros with patients in rural areas. “Doctors who want to be a part of social welfare initiatives but don’t have the time for health camps find this an effective way to reach out to the underserved,” said Abhishek Dwivedi, co-founder of New Delhi-based online doctor consultation platform Alternacare. “Some districts in Maharashtra and Uttar Pradesh have just one doctor for a population of 2 lakh, so these doctors feel they are touching lives by engaging with us,” he said. Alternacare, which was started in January 2016 raised $500,000 in seed funding from US-based Eros Labs in September.

Lower costs

In the city, doctors usually charge between Rs 500 and Rs 600 per consultation, but lower their rates to Rs 150-Rs 200 per consultation online. Bengaluru-based Dr Swati Rajagopal, who specializes in tertiary care for infectious diseases and HIV management, has handled patients via telemedicine for more than a year. “Caregivers of seniors find it difficult to bring patients to hospital every time they have a query about dosage or diet. Instead, they can call and get their doubts resolved instantly,” she said.India poses a unique challenge for telemedicine as patriarchy at times dictates access to medical care as well as spending on health.In the case of Pooja Rathore, for instance, her husband flatly refused to donate blood, and two employees at Karma had to step in. “It was shocking. But this is just one of many instances of abuse, neglect and misogyny. More than technology, we need social change so that women’s health is taken seriously,” said Jagdeep Gambhir, founder, Karma Healthcare, which received an undisclosed amount of funding from Austria-based Ennovent Impact Investment Holding last year. “Women are dependent on men to take them to doctors. Finance is another constraint, and many men believe ‘female complaints’ don’t warrant medical attention,” said Gambhir.For Gambhir, the journey has been from technology to social welfare. After working as a technology analyst with investment bank Goldman Sachs, he worked in two non-profits, Innovators in Health and Population Foundation of India. After spending 18 months in a small town in Bihar, which had deplorable healthcare, Gambhir decided to set up Karma Healthcare in 2014.Startups also offer more than five modes of payment. “The most popular is paying us through mobile phone top-ups. We have also tied up with the last-mile delivery partners of Amazon, Flipkart and Snapdeal, so that their delivery boys collect payment en-route. This makes more than 17,000 pincodes in India available to us,” said Dwivedi of Alternacare.

No mental health care

What is proving hard for startups though is convincing psychiatrists and mental health specialists, of which there is a severe shortage in India, to get on board. There is demand for phone consultations for conditions such as schizophrenia and clinical depression, but the duration of the consultation — 30 minutes to an hour — is a road block for professionals.According to industry body Assocham, the telemedicine sector is expected to double to $32 million (about Rs 210 crore) by 2020. Its market size stands at $15 million (about Rs 100 crore) as of June 2016.“In the rapidly evolving and complex field of medicine, there is a need for collaboration among doctors to coordinate patient care. Startups are using mobile apps to revolutionize digital health by making it easy for physicians to share knowledge and holistically manage patient care,” said Gurpreet Singh, founder, Roundglass Partners, which has invested in Curofy, a networking platform for doctors.

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As the Special Chief Secretary & IT Advisor to the Chief Minister - Govt. of Andhra Pradesh, J A Chowdary is all for chasing new growth horizons, pursuing radically different development approaches and outguessing technology trends that will shape the future.

As the Special Chief Secretary & IT Advisor to the Chief Minister - Govt. of Andhra Pradesh, J A Chowdary is all for chasing new growth horizons, pursuing radically different development approaches and outguessing technology trends that will shape the future.